Child Fatalities from Maltreatment:
National Data Could Be Strengthened
GAO-11-811T: Published: Jul 12, 2011. Publicly Released: Jul 12, 2011.
This testimony discusses child fatalities from maltreatment. Every year, children in the United States die after being physically abused, severely neglected, or otherwise maltreated, frequently at the hands of their parents or others who are entrusted with their care. Infants and toddlers are the most vulnerable to such abuse and neglect. According to estimates by the National Child Abuse and Neglect Data System (NCANDS), 1,770 children in the United States died from physical abuse or other forms of maltreatment in fiscal year 2009. Some experts believe that more children have died from maltreatment than are captured in this estimate and that there are inconsistencies and limitations in the data that states collect and report to NCANDS. In addition, many more children are severely harmed and may nearly die from maltreatment, but NCANDS does not collect data specifically on near-fatalities. The Department of Health and Human Services (HHS) maintains NCANDS, which is a voluntary state data-reporting system. HHS provides oversight of state child welfare systems, and in all states, child protective services (CPS) is part of the child welfare system. When state CPS investigators determine that a child's death is considered maltreatment under state laws or policies, CPS documents the case, and the state's child welfare department reports it to NCANDS. This testimony today is based on our July 2011 report, which is being publicly released today and addresses three issues: (1) the extent to which HHS collects and reports comprehensive information on child fatalities from maltreatment; (2) the challenges states face in collecting and reporting information on child fatalities from maltreatment to HHS; and (3) the assistance HHS provides to states in collecting and reporting data on child fatalities from maltreatment.
More children have likely died from maltreatment than are reflected in the national estimate of 1,770 child fatalities for fiscal year 2009. Undercounting is likely due to nearly half the states reporting to NCANDS data only on children already known to CPS agencies--yet not all children who die from maltreatment were previously brought to the attention of CPS. HHS encourages states to obtain information on child maltreatment fatalities from other non-CPS sources of information, but 24 states reported in our survey that their 2009 NCANDS data did not include child fatality information from any non-CPS sources. Synthesizing information about child fatalities from multiple sources--such as death certificates, state child welfare agency records, or law enforcement reports--can produce a more comprehensive picture of the extent of child deaths than sole reliance on CPS data. Furthermore, inconsistent state definitions of maltreatment, differing state legal standards for substantiating maltreatment, and missing state data can complicate the ability to obtain comprehensive information on child fatalities from maltreatment across states or over time. In addition to collecting the number of child fatality deaths, NCANDS collects data on the circumstances surrounding these deaths, which could be useful for prevention, but not all of this information is synthesized or published in HHS's annual Child Maltreatment report. Local child death investigators, such as law enforcement officials, coroners and medical examiners, and CPS staff, face several challenges in determining whether a child's death was caused by maltreatment. One challenge is that without definitive medical evidence, it can be difficult to determine that a child's death was caused by abuse or neglect rather than natural causes. State and local resource constraints can also limit investigators' ability to conduct testing, such as autopsies, to determine how a child died. Another challenge in determining cause of death is that the level of skill and training for coroners and medical examiners can vary greatly, according to the National Academy of Sciences. Child death investigators can also differ in their interpretation and application of maltreatment definitions, which can lead to inconsistent determinations of the cause of death. Finally, states reported challenges coordinating among geographic jurisdictions and with other state agencies, such as health departments, to obtain information on child fatalities from maltreatment. HHS provides ongoing assistance to states for reporting child maltreatment fatality data through an NCANDS technical assistance team that hosts an annual technical assistance meeting, provides Web-based resources, and uses an NCANDS Listserve to share information with states and facilitate peer-to-peer assistance. In addition, HHS provides assistance to states' child death review teams through the National Center for Child Death Review (NCCDR), which helps states share information by publishing their child death review teams' contact information, data, and annual reports on its Web site. In the report we released today, we recommended that the Secretary of HHS take steps to (1) further strengthen data quality, such as by identifying and sharing states' best practices and helping address differences in state definitions and interpretation of maltreatment; (2) expand available information on the circumstances surrounding child fatalities from maltreatment; (3) improve information sharing on the circumstances surrounding child fatalities from maltreatment; and (4) estimate the costs and benefits of collecting national data on near fatalities.